NPIMap

Organization Active NPI

Penn North Centers for Advanced Wound Care PC

  • Surgery Physician
  • Erie, PA
National Provider Identifier
1003897307
Registry record updated Sep 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PENN NORTH CENTERS FOR ADVANCED WOUND CARE PC
Practice address
232 W 25TH St
Erie, PA 16544-0002
Phone
(814) 452-7878
NPI assigned
Nov 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Thomas E Serena, MD
Title
Ceo
Phone
(814) 452-7878

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0011X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X

Addresses

Primary practice location

232 W 25TH St
Erie, PA 16544-0002

Mailing address

232 W 25TH St
Erie, PA 16544-0002
Phone (814) 452-7878

Other identifiers 2

IdentifierTypeStateIssuer
100964725MedicaidPA
DC2954OtherRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Locations

229 3rd St
Cambridge, MA 02142

8407 15th Ave
Brooklyn, NY 11228
Phone (718) 921-2156

200 Renaissance Dr
Ste 200
Butler, PA 16001
Phone (724) 282-0755

232 W 25th St
Erie, PA 16544
Phone (814) 452-5337

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1003897307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-7878",
            "fax_number": "814-452-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 W 25TH ST",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165440002",
            "telephone_number": "814-452-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN NORTH CENTERS FOR ADVANCED WOUND CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-14",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "SERENA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "814-452-7878",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100964725",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC2954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.